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1205172715 NPI number — PHLOGICS

NPI Number: 1205172715
Health Care Provider/Practitioner: PHLOGICS

Information about “1205172715” NPI (PHLOGICS) exists in 1205172715 in HTML format HTML  |  1205172715 in plain Text format TXT  |  1205172715 in PDF (Portable Document Format) PDF  |  1205172715 in an XML format XML  formats.

NPI Number : 1205172715 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205172715",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PHLOGICS",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 720999",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DALLAS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75372-0999",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "469-552-9979",
    "MailingAddressFaxNumber": "973-828-0669",
    "FirstLinePracticeLocationAddress": "801 E CAMPBELL RD STE 350",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RICHARDSON",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75081-1889",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "469-552-9979",
    "PracticeLocationAddressFaxNumber": "214-910-7908",
    "EnumerationDate": "01/02/2013",
    "LastUpdateDate": "03/17/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ADAMS",
    "AuthorizedOfficialFirstName": "KENNETH",
    "AuthorizedOfficialMiddleName": "KEI",
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "469-552-9979",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208100000X",
        "TaxonomyName": "Physical Medicine & Rehabilitation Physician",
        "LicenseNumber": "K5441",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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